Qaseem and colleagues' first recommendation in their guideline on pressure ulcer treatment (1) is that “clinicians use protein or amino acid supplementation in patients with pressure ulcers to reduce wound size.” They note that “evidence for the optimal dose or form of protein was insufficient.”

Of the 14 cited studies, 5 focus on arginine supplementation and 1 each on a proprietary formulation; a collagen protein hydrolysate; and ornithine α-ketoglutarate, presumably the recommended amino acid supplementation. Of the 5 studies of arginine, that of Benati and associates (n = 16; 3 groups; duration, 2 weeks) (2) provides no statistics. Brewer and coworkers' study (n = 35) (3) uses historical control participants. Desneves and colleagues' study (n = 16; 3 groups; duration, 3 weeks) (4) finds worse outcomes with protein supplementation unless it is enriched with arginine. Meaume and associates' study (n = 23; duration, 3 weeks) (5) compares 2 doses of arginine and concludes that they are equally effective. van Anholt and coworkers' study and the title of the journal in which it was published were not found in PubMed or Google Scholar. Qaseem and colleagues also note that the relationship between reduction in wound size and complete healing is uncertain.